Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, Scotland, United Kingdom.
Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, Scotland, United Kingdom.
Vaccine. 2019 Jan 3;37(1):69-75. doi: 10.1016/j.vaccine.2018.11.033. Epub 2018 Nov 22.
Mandatory policies have the potential to increase uptake of influenza ('flu') vaccination among healthcare workers (HCWs), but concerns have been expressed about their acceptability and effectiveness. We explored views on three mandatory policies (declination forms, face masks or reduced patient contact, and mandatory vaccination) among both HCWs and flu vaccination programme managers in the National Health Service (NHS) in England.
A mixed method approach was employed. An online cross-sectional survey was conducted with staff responsible for implementing influenza campaigns in NHS trusts (healthcare organisations) in England (n = 72 trusts). The survey measured perceived effectiveness of the three mandatory policies and perceived support for them among HCWs. Qualitative interviews were conducted in four trusts, with influenza campaign managers (n = 24) and with HCWs who had the opportunity to receive the influenza vaccination (n = 32). Interviews explored respondents' views of the three strategies and were analysed thematically using QSR NVivo 11 All data were collected shortly after the 2016/2017 influenza season.
In the survey, views varied on the effectiveness of the three policies and none of the interventions were thought to be strongly supported by HCWs, with particularly low levels of support perceived for mandatory vaccination and for face masks or reduced patient contact. The qualitative interviews revealed substantial concerns around the practicability and enforceability of mandatory policies and the potential discriminatory effect on HCWs who made a principled decision or had medical reasons for exemption. Additional doubts were also expressed regarding the effectiveness of face masks and their potential to worry patients, and the ethics of compelling staff to accept medical intervention.
Mandatory vaccination and face masks would not be strongly supported if introduced in the UK. If declination forms are adopted, they should be used in a constructive intelligence-gathering manner which avoids stigmatising HCWs.
强制性政策有可能提高医护人员（HCWs）对流感（“flu”）疫苗的接种率，但人们对这些政策的可接受性和有效性表示担忧。我们在英格兰国民保健制度（NHS）中调查了 HCWs 和流感疫苗接种计划管理人员对三种强制性政策（拒绝表格、戴口罩或减少与患者接触以及强制接种疫苗）的看法。
采用混合方法。对英格兰 NHS 信托机构（医疗机构）负责实施流感运动的工作人员进行了在线横断面调查（n=72 个信托机构）。该调查衡量了三种强制性政策的有效性以及 HCWs 对这些政策的支持程度。在四个信托机构中进行了定性访谈，访谈对象包括流感运动经理（n=24）和有机会接种流感疫苗的 HCWs（n=32）。访谈探讨了受访者对这三种策略的看法，并使用 QSR NVivo 11 进行了主题分析。所有数据均在 2016/2017 流感季节后不久收集。
在调查中，人们对这三种政策的有效性看法不一，没有一种干预措施被认为得到 HCWs 的大力支持，尤其是对强制接种疫苗和戴口罩或减少与患者接触的措施支持率较低。定性访谈揭示了对强制性政策的可操作性和可执行性以及对做出原则性决定或因医疗原因豁免的 HCWs 的潜在歧视性影响的巨大担忧。此外，还对口罩的有效性及其对患者的潜在担忧以及强迫员工接受医疗干预的伦理问题表示怀疑。
如果在英国引入强制性接种疫苗和戴口罩，它们不会得到大力支持。如果采用拒绝表格，应将其用于以建设性的方式收集情报，避免污名化 HCWs。
